Effectiveness of Single Fetal Membrane Sweeping in Reducing Elective Labor Induction for Postdate Pregnancies (38+0 to 40+6 Weeks): A Randomized Controlled Trial.

BACKGROUND:  Postdate pregnancy is characterized by a heightened risk for both maternal and perinatal complications. Owing to the risks, clinicians frequently turn to elective labor induction as a management strategy for postdate pregnancies. However, patients are increasingly informed and apprehensive about this approach and its associated risks. This has prompted a search for alternative management methods that may encourage spontaneous labor in pregnant women. One such approach is the use of fetal membrane sweeping, a method known to increase the likelihood of spontaneous labor onset. Yet, it remains unclear whether a single fetal membrane sweeping procedure can effectively reduce the need for elective labor induction in postdate pregnancies while minimizing risks to both the mother and fetus. OBJECTIVES: The primary objective of this study was to assess the efficacy of a single fetal membrane sweeping procedure conducted between 38+0 and 40+6 weeks of gestation in reducing the rate of elective labor induction among postdate pregnancies at Central Hospital Benin City, Nigeria. Secondary objectives included evaluating the impact of membrane sweeping on maternal and perinatal outcomes. METHODOLOGY: This open-label superiority randomized controlled study was carried out from June 2020 to March 2021, following ethical approval from the Hospital Management Board (HMB). One hundred and forty eligible participants, without contraindications to vaginal delivery, were randomly assigned to one of two groups. The first group received a single fetal membrane sweeping procedure between 38+0 and 40+6 weeks of gestation, while the control group underwent vaginal examination only to assess the Bishop score. Participants were monitored until delivery. Data analysis was performed. Results were considered statistically significant at p < 0.05. RESULTS: The implementation of a single fetal membrane sweeping procedure effectively reduced the incidence of elective labor induction. Specifically, the membrane sweep group exhibited a significantly lower rate of elective labor induction compared to the control group (9.0% vs. 27.1%; p=0.0083). Moreover, a substantial proportion of the treatment group (91.4%) experienced spontaneous labor, while the control group reported a rate of 72.9%. The difference was statistically significant (p=0.0054). Notably, the control group exhibited a significantly longer mean time interval from recruitment to delivery (10.67±3.51 days) than the membrane sweeping group (3.64±4.123 days; p<0.05). Also, postdate women in the membrane sweep group were less likely to require cervical ripening with Foley's catheter than those in the control group (33.3% vs. 100%; RR: 0.33 (0.11-1.03); p=0.0057). Still, maternal satisfaction was significantly higher in the membrane-sweeping group (p<0.01). No significant differences were noted across the groups in maternal and neonatal outcomes. CONCLUSION: In low-risk term pregnancies, a single fetal membrane sweeping procedure is a superior alternative to no membrane sweeping in reducing the rate of elective labor induction for postdate pregnancies and in shortening the duration of term pregnancy.

Oral Health Considerations for Adults Aged 18 Years or More Seeking Dental Care in the Past Year: A CDC Oral Health Data Analysis.

BACKGROUND:  Oral health is an essential aspect of overall well-being, with regular dental care being fundamental to its maintenance. This study focuses on understanding dental care utilization among adults aged 18 and above who have visited a dentist or dental clinic in the past year, aiming to uncover patterns, disparities, and determinants of oral health practices within this demographic. METHODS:  Data from the U.S. Centers for Disease Control and Prevention (CDC) Oral Health dataset were utilized to conduct this analysis. The dataset encompasses a diverse and nationally representative sample of adults aged 18 and above. The study explored the proportion of adults who sought dental care between 2008 and 2020, further stratified by demographic variables including age, gender, income, education, and race. The analysis provides insights into the prevalence of dental care utilization and the role of demographic factors in shaping oral health behaviors. RESULTS:  The study found that 64.8% (n =397,291; 95% CI: 64.4 - 65.2) of adults aged 18 and above visited a dentist or dental clinic in 2020. Subgroup analysis revealed variations in dental care use by age, gender, income, education, and race. Among genders, 67.4% (n = 150,510; 95% CI: 66.9 - 67.9) of females sought care in 2020, compared to 61.9% (n = 116,535; 95% CI: 61.4 - 62.4) of males. Those earning >$50,000 had the highest proportion, 75.3% (n = 13,363; 95% CI: 74.8 - 75.8), seeking care. Among racial groups, White adults had the highest proportion, 68.4% (n = 204,486; 95% CI: 68.0 - 68.8) in 2020. In education groups, college graduates or professionals had the highest, 77.3% (n = 121,800; 95% CI: 76.8 - 77.8) in 2020. Among ages, adults aged 65+ had the highest proportion, 67.1% (n = 96,012; 95% CI: 66.4 - 67.8) in 2020. However, as age decreased, dental visit proportion generally remained within the same range. CONCLUSION:  This study enhances our understanding of dental care utilization patterns within the studied population, shedding light on disparities in oral health practices. Moreover, it provides insight into how demographic factors shape dental/oral healthcare-seeking behaviors. Ultimately, these insights guide efforts to improve oral health outcomes and well-being within this population.

Prevalence and Factors Associated With Awareness of Precision Medicine Among Individuals With Depression and Anxiety.

OBJECTIVE: This study investigates the prevalence and determinants of awareness of precision medicine among a nationally representative sample of individuals with self-reported depression and anxiety in the United States." METHODS: Data were obtained from the Health Information National Trends Survey (HINTS) 5, Cycle 4, which is a study administered by the National Cancer Institute and is nationally representative. The survey, conducted between February and June 2020, targeted non-institutionalized, civilian US adults aged 18 years and older. Utilizing survey-weighted logistic regression, predictors of precision medicine awareness were assessed, encompassing sociodemographic, health-related, and technological factors. RESULTS: Among 890 individuals with self-reported depression and/or anxiety, approximately 15.3% reported awareness of precision medicine. Participants who had a higher level of education and those who had increased health-linked social media usage were three times more likely to be aware of precision medicine compared to those who did not. Old age was also positively associated with increased awareness. CONCLUSION: The present study's findings have disclosed an alarming lack of awareness of precision medicine, particularly among mentally ill persons with anxiety or depression, in which the targeted subgroups, including individuals with lower education levels and limited health-linked social media utilization, indicated lower levels of awareness. As such, it is recommended that such disparities be tackled using customized interventions along with educational initiatives, as this is likely to improve awareness levels while also ensuring equitable and increased access to precision medicine within the context of mental health.

Trends in Arthritis Prevalence and Associated Chronic Health Indicators Among Adults: Insights From the Behavioral Risk Factor Surveillance System (BRFSS) Database.

Background Arthritis is a prevalent, chronic condition with significant implications for morbidity and healthcare utilization. Understanding trends in arthritis prevalence and associated chronic health indicators is vital for informing public health interventions and healthcare policies. Objective This retrospective study aimed to analyze trends in arthritis prevalence and associated chronic health indicators among adults using data from the Behavioral Risk Factor Surveillance System (BRFSS) database. Methods This retrospective study utilized data from the BRFSS database covering 2019 to 2022. Participants included United States adults aged 18 years and older who completed BRFSS surveys during the specified period. Primary variables included arthritis prevalence and its correlation with chronic health indicators and demographics. Data collection involved standardized telephone questionnaires administered annually, with rigorous attention to data quality and consistency. Prevalence estimates were calculated using weighted proportions, and statistical analysis utilized analysis of variance (ANOVA). Results The study revealed relatively stable arthritis prevalence over the study period, with notable demographic variations. Arthritis prevalence remained stable (2019: 43.3%, 2021: 42.5%). Females consistently had higher rates than males (2019: 45%, 2021: 44.9%). Activity limitation, joint pain, and work limitation were more prevalent in arthritis patients. White, non-Hispanic individuals had higher rates than other groups. Physical inactivity increased from 2019 (29.4%) to 2022 (72.4%), particularly in males. Counseling for physical activity was lower in males. Targeted interventions are needed to address these disparities and improve arthritis management. Conclusion This study provides insights into trends in arthritis prevalence and associated chronic health indicators among United States adults. The findings underscore the importance of considering demographic factors in arthritis prevention and management strategies. Targeted interventions promoting physical activity counseling, particularly among high-risk populations, are warranted to address the rising trend of physical inactivity among individuals with arthritis.

Burden and Predictors of Depression in Populations With Coronary Heart Disease.

INTRODUCTION: Depression significantly impacts the quality of life and medical care in patients with coronary heart disease (CHD). This study assesses the burden of depression in adults aged 40 years and above with CHD and evaluates predictors of depression in this population. It has been reported that approximately 17-44% of persons with CHD have a major depression diagnosis and that nearly 27% of individuals undergoing coronary artery bypass graft operation suffer depression following the procedure.  Methods: Data from the 2022 National Health Interview Survey was used. The sample was made up of adults 40 years and above with CHD. A chi-square analysis was used to identify differences between those who were depressed and those who were not. Logistic and ordinal regression analyses were used to identify predictors of depression and severe depression, respectively. RESULTS: The proportion of adults 40 years and above with CHD who reported having depression was 863/1700 (50.5%). Among those who were ≥65, the proportion of those who reported depression and those who did not were similar (49.3% vs. 50.7%). Most women reported having depression (57.4% vs. 42.6%), while fewer men reported having depression (46.3% vs. 53.7%). The positive predictors of depression include being insured (odds ratio (OR) 1.26 (1.05-1.53), p = 0.016), college degree (OR 1.09 (1.01-1.18), p = 0.040), diabetes mellitus (OR 1.28 (1.15-1.42), p < 0.001), and hypertension (OR 1.34 (1.24-1.44), p < 0.001). The negative predictors of being depressed were age ≥65 (OR 0.74 (0.69-0.80), p < 0.001), male sex (OR 0.54 (0.50-0.58), p < 0.001), and ratio of family income (RFI) ≥1 (OR 0.68 (0.61-0.77), p < 0.001). The positive predictors of severe depression include diabetes mellitus (OR 1.38 (1.06-1.81), p = 0.019) and current cigarette use (OR 2.10 (1.44-3.07), p < 0.001). CONCLUSION: A significant proportion of adults 40 years and above with CHD have depression, and socioeconomic and cardiovascular risk factors are associated with a high likelihood of depression. Cardiovascular risk factors alone predict the likelihood of severe depression. Interventions to address depression in CHD should target specifically these high-risk individuals.

Analyzing Obesity Trends in American Children and Adolescents: Comprehensive Examination Using the National Center for Health Statistics (NCHS) Database.

Background In the USA, obesity in children and adolescents has become a major public health concern. Childhood obesity has been linked to various cardiometabolic comorbidities all through one's life. Owing to the significant increment in childhood obesity rates, there has been an urgent need for the identification of the correlates and antecedents of adiposity and the cardiometabolic risk to enable early prevention of obesity. As such, the objective of this study is to analyze obesity trends in American children and adolescents from 1999 to 2018 using the National Center for Health Statistics (NCHS) database, as this will enable the identification of various risk factors and early prevention of childhood obesity. Objective This study aimed to comprehensively examine demographic factors impacting obesity prevalence, including gender, age groups (two to five, six to 11, and 12-19 years), race/ethnicity, and poverty level. Methods The study conducted a retrospective analysis using the NCHS database from 1999 to 2018. Utilizing NCHS data, we examined the evolution of obesity prevalence among children and adolescents. The analysis focused on demographic variations, including gender, age, race/ethnicity, and percentage of poverty level. SPSS version 24, a statistical software by IBM Corp. (Chicago, IL, USA), was used for database summarization, graphical representation, and presenting prevalence trends across all participants. Results Temporal trends in obesity prevalence exhibited notable fluctuations from 1999 to 2018. Utilizing NCHS data, the study revealed demographic disparities in age groups, genders, race/ethnicities, and socioeconomic status categories. Gender-based obesity variations persist, with boys consistently surpassing girls in prevalence (17.5% vs. 16%, p = 0.0231). Varied age group patterns emerged, peaking at 18.7% in 12-19 years, 17.7% in six to 11 years, and 11.2% in two to five years. Racially, Hispanic individuals had the highest prevalence (22.8%), followed by Mexican (22.0%) and Black or African American-only individuals (20.6%). White-only individuals showed 14.4%, and Asian-only individuals exhibited the lowest (9.4%). Lower socioeconomic brackets correlate with higher obesity instances, particularly below the 100% poverty level (20%). The 100-199%, 200-399%, and 400% or more categories contributed 18.6%, 16.6%, and 11.6%, respectively. Conclusion Our extensive examination of obesity trends among American children and adolescents from 1999 to 2018, utilizing the NCHS database, provides valuable insights into the complex interplay of demographic factors influencing this public health concern. The study reveals age-specific variations, emphasizing unique challenges during adolescence. Gender disparities, socioeconomic influences, and racial/ethnic impacts are evident, underscoring the need for further study. Our findings present several policy implications regarding the development of interventions aimed at reducing childhood obesity rates in the USA. For instance, the findings indicate the need for policymakers to develop policy interventions aimed at enabling the prevention of obesity during early infancy stages. The findings highlight the need for interventions aimed at reducing the obesity disparities observed between genders and races/ethnic groups. Developing and executing the interventions is prone to considerably reduce the obesity prevalence rates among children and adolescents in the USA.

A Systematic Review of the Effect of Stigmatization on Psychiatric Illness Outcomes.

A significant proportion of individuals with psychiatric disorders face dual challenges such as managing the symptoms and disabilities of their conditions and enduring stigma arising from misconceptions about mental illness. This stigma denies them quality-of-life opportunities, such as access to satisfactory healthcare services, better employment, safer housing, and social affiliations. This systematic review aims to evaluate the effect of stigmatization on psychiatric illness outcomes, particularly its influence on treatment adherence, treatment-seeking behavior, and care outcomes. We conducted a systematic review of 39 studies published between 2010 and 2024, focusing on the effects of stigmatization on psychiatric illness outcomes. The review utilized robust methodology following Cochrane guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from 2010 to 2024 obtained from databases such as PubMed, Embase, Google Scholar, Web of Science, and SCOPUS. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies, with most studies rated as moderate to high quality. The findings indicate that stigma in psychiatric illness is closely associated with several factors, including illness duration (mean effect size = 0.42, p < 0.05), frequency of clinic visits (mean reduction = 2.3 visits/year), and diagnosis of psychotic disorders (OR = 1.78, 95% CI: 1.20-2.65). Stigma manifests through misinformation, prejudice, and discrimination, leading to significant barriers to accessing and adhering to psychiatric treatment, thereby worsening health outcomes. It leads to delays in accessing healthcare, poor adherence to medication and follow-up, and negative psychiatric health outcomes, including disempowerment, reduced self-efficacy, increased psychiatric symptoms, and decreased quality of life. Also, stigma extends to caregivers and healthcare professionals, complicating care delivery. This review highlights the need for effective interventions and strategies to address stigma, emphasizing the importance of educational interventions to mitigate the adverse effects of public stigma. Understanding the multifaceted nature of stigma is crucial for developing targeted approaches to improve psychiatric care outcomes and ensure better mental health services for individuals with mental illnesses.

COVID-19 Vaccination Rates and Predictors of Uptake Among Adults With Coronary Heart Disease: Insight From the 2022 National Health Interview Survey.

INTRODUCTION: COVID-19 has become a burden to all nations across the globe, and vaccination currently remains the most effective means of fighting the SARS-COV-2 pandemic. From the time of approval and subsequent distribution of the various COVID-19 vaccines, nearly 72.3% (5.5 billion) of the globe's population have been vaccinated, leaving slightly more than a quarter of the globe's population at risk. With the approval and availability of booster vaccine dosages to individuals with chronic conditions, including coronary heart disease (CHD), it is vital to comprehend the factors underlying the uptake of COVID-19 vaccination in such subgroups. Further, the American Heart Association recommends vaccination against COVID-19 in populations with coronary heart disease (CHD). This is because they are more likely to experience severe outcomes due to COVID-19 infection. This study assesses the uptake of COVID-19 vaccines as well as predictors of its uptake. METHODS: Using the 2022 survey data from the National Health Interview Survey (NHIS), 1,708 adults ≥ 40 years with CHD who responded yes/no to whether they had received the vaccine were identified. A Pearson's chi-square test was used to ascertain differences among those who had received the vaccine and those who had not. A logistic regression (multivariate regression) was used to evaluate predictors of COVID-19 vaccination. RESULTS: About 1,491/1,708 (86.8%) adults ≥ 40 years reported being vaccinated against COVID-19. Among them, 1,065/1,491 (68.4%) had received more than two vaccination doses. The predictors of COVID-19 vaccination were older age (odds ratio (OR): 2.01 (95% confidence interval (CI): 1.40-2.89), p < 0.001), ratio of family income to poverty threshold of 1 and above (OR: 2.40 (95% CI: 1.58-3.64), p < 0.001), having a college degree (OR: 3.09 (95% CI: 1.85-5.14), p < 0.001), and being insured (OR: 3.26 (95% CI: 1.03-10.26), p = 0.044). CONCLUSION: The findings of the study have indicated that 68.4% of adults 40 years and above with CHD have been vaccinated against COVID-19 and have received more than two doses of vaccines. More than half have followed recommendations and have received booster doses of the vaccine. Old age (above 40 years) and a higher socioeconomic class are associated with being more likely to follow COVID-19 vaccination guidelines. Despite the higher vaccination rate of 68.4% in the adults with heart diseases group, strategies for improving booster vaccine awareness alongside accessibility are needed to enhance additional dosage uptake, protect them against novel COVID-19 variants, and ensure the development of sustained immunity.

Ensuring Continuity of Care: Effective Strategies for the Post-hospitalization Transition of Psychiatric Patients in a Family Medicine Outpatient Clinic.

In healthcare, continuity of care is a crucial element, especially for patients in the field of psychiatry who have recently been discharged from a hospital. The shift from inpatient to outpatient care poses challenges for patients and healthcare providers, including openness to treatment, competing priorities, financial insecurity, concerns and dilemmas faced by patients regarding their post-hospitalization life after improvements in symptoms, lack of social support, poor patient-doctor relationships, lack of insight, and stigma associated with mental illness. Therefore, it is vital to employ effective strategies to ensure patients receive the required care and support during this transition. This review delves into the significance of continuity of care for psychiatric patients post-hospitalization, effective strategies for the transition, and the challenges and barriers to implementation from the perspective of a family medicine practice. To analyze physicians' role in managing psychiatric patients post-hospitalization, we developed a comprehensive search strategy. This involved extracting relevant data, updates, guidelines, and recommendations. Our search spanned various online repositories, such as PubMed and Google Scholar, specifically focusing on US-based guidelines aligned with our objectives. The search was conducted using medical subject headings (MeSH) and combinations of "OR," "AND," and "WITH." We crafted keywords to optimize our search strategy, including psychiatric illness, post-hospitalization, follow-up, follow-up care, primary care follow-up, and guidelines. Exploring online repositories yielded 132 articles, and we identified some guidelines that addressed our objectives. We established inclusion and exclusion criteria for our review and reviewed 21 papers. Post-hospitalization follow-up is a critical facet of psychiatric care, aligning with guidelines from the American Psychiatric Association and other relevant sources. Emphasizing continuity of care ensures a smooth transition from inpatient to outpatient settings, sustaining therapeutic momentum and minimizing the risk of relapse. This comprehensive approach involves careful medication management, regular mental health assessments, education on condition-specific coping strategies, and coordinated care between healthcare providers. It includes conducting risk assessments, safety planning, building social support and community integration, prompt post-hospitalization follow-up, and tailored treatment plans. Together, these measures enhance overall wellness for recently discharged patients. This holistic strategy tackles pressing short-term needs while facilitating long-term stability, promoting resilience and successful community reintegration, reducing readmission likelihood, and ultimately supporting sustained recovery.

Children With Special Health Care Needs: An Analysis of National Survey of Children's Health Database.

Background Children with Special Health Care Needs (CSHCN) represent a diverse pediatric population requiring healthcare services beyond typical childhood needs. This study analyzes data from the 2016-2020 National Survey of Children's Health Database to elucidate demographic patterns, prevalence rates, and nuanced factors influencing the health and well-being of CSHCN. Methods This retrospective observational study focuses on children aged 0-17 who are identified as CSHCN based on Maternal and Child Health Bureau criteria. A comprehensive analysis of the National Survey of Children's Health (NSCH) database examines key variables, including health outcomes, healthcare utilization, parental-reported health status, and socio-demographic factors. Stratified random sampling ensures national representation. Results The study encompassed 40,335 patients, revealing that 14.6% (CI: 14.0-15.3, n=6,445) of CSHCN received care in a well-functioning system. Across age groups, 19.1% (CI: 14.0-15.3, n=6,445) of CSHCN aged 0-5 received ongoing treatment, contrasting with 5.7% (CI: 5.2-6.2, n=1,599) in the 12-17 years group. Males exhibited a prevalence of 15% (CI: 14.1-15.9, n=3,674), and females had 14.2% (CI: 13.2-15.2, n=2,771). Racial disparities were noted; non-Hispanic Native Hawaiian/Other Pacific Islander children had a 3% (CI: 1.1-8.1, n=6) prevalence. Across Federal Poverty Level categories, prevalence ranged from 12.5% (CI: 11.5-13.6, n=1,753) to 17.7% (CI: 16.6-18.9, n=2,856). Notably, 18.5% (CI: 17.4-19.7, n=3,515) of children without adverse experiences were CSHCN. Among CSHCN in two-parent currently married households, 15.9% (CI: 15.0-16.8, n=4,330) received treatment, while those in unmarried households had a prevalence of 12.9% (CI: 10.5-15.7, n=335). CSHCN with parents born in the United States showed a prevalence of 15.4% (CI: 14.7-16.1, n=5,257). Conclusion This study provides valuable insights into the prevalence and demographic patterns of CSHCN. Limitations include potential recall bias and the retrospective study design. Despite these constraints, the findings lay a foundation for future research and targeted interventions, fostering a deeper understanding of the evolving landscape of pediatric healthcare in the United States.

Analyzing Trends in Mental and Behavioral Health Support for Children: A Comprehensive Study Using National Survey of Children's Health Database.

Objective This study aimed to explore mental and behavioral health support trends for children aged 3-17, analyzing treatment and counseling using United States data from the 2016-2020 National Survey of Children's Health (NSCH) database. Methods Employing a retrospective observational design, we systematically retrieved and analyzed NSCH Database data from 2016 to 2020. The focus was on understanding mental and behavioral health treatment percentages over time, specifically targeting demographic variations such as age groups, gender, race/ethnicity, and the federal poverty level percentage. Graphical representation utilized Excel, summarizing results based on aggregated data for distinct time intervals, highlighting the importance of mental and behavioral health support for children aged 3-17. Results The study identified significant temporal trends in mental and behavioral health treatment, revealing notable fluctuations across demographic and socio-economic variables. Of the 22,812 participants, 51.7% (CI: 50.2-53.1%, n=12,686) received treatment, exposing disparities. Gender differences were evident, with higher treatment rates in females (53.7%, CI: 51.6-55.9%, n=6,166) than males (50.1%, CI: 48.2-52.0%, n=6,520). Age-specific patterns indicated lower intervention rates in younger children (33.5%, CI: 28.6-38.8%, n=447, ages 3-5) compared to adolescents (58.1%, CI: 56.2-59.9%, n=8, 222 ages 12-17). Conclusion The conclusion highlights significant temporal fluctuations and pronounced demographic disparities. Findings underscore varying prevalence rates among age groups, genders, racial/ethnic backgrounds, and socio-economic status categories. This study provides valuable insights for policymakers, healthcare professionals, and researchers, informing targeted interventions to enhance mental and behavioral health support for United States children.

COVID-19 Vaccination Rates and Predictors of Vaccine Uptake Among Adults With Chronic Obstructive Pulmonary Disease: Insights From the 2022 National Health Interview Survey.

Background and objective The coronavirus disease 2019 (COVID-19) vaccination rates and predictors of vaccine uptake among patients with chronic obstructive pulmonary disease (COPD) in the United States are unknown. In light of this, we assessed COVID-19 vaccination rates in this population and evaluated predictors of vaccine uptake. Methods Using 2022 survey data from the National Health Interview Survey (NHIS), 1486 adults with COPD who responded with "yes/no" to whether they had received the COVID-19 vaccine were identified, including those who had received booster doses. A chi-square test was used to ascertain differences between those who had received the vaccine and those who had not, as well as between those who had received booster doses and those who had not. A logistic regression was used to evaluate predictors of COVID-19 vaccination uptake. Results A total of 1195 individuals among 1486 respondents with chronic pulmonary disease (78.4%) had been vaccinated against COVID-19, and 789/1195 (62.5%) had received booster shots. The majority of individuals were aged 65 years and above, exceeded the 1+ threshold for the ratio of family income to poverty (RFIP), and were covered by insurance. Positive predictors of COVID-19 vaccination were as follows: age 40 - 64 years (OR: 2.34, 95% CI: 1.31 - 4.19; p=0.004) and 65 years and above (OR: 1.93, 95% CI: 1.36 - 2.72; p<0.001), RFIP threshold of ≥1 (OR: 2.02, 95% CI: 1.42 - 2.88; p<0.001), having a college degree (OR: 1.92, 95% CI: 1.92 - 3.26, p=0.016), and being insured (OR: 3.12, 95% CI: 1.46 - 6.66, p=0.003). The current smoking habit negatively predicted the uptake (OR: 0.54, 95% CI: 0.33 - 0.87, p=0.012). The positive predictors of COVID-19 vaccination boosters were as follows: age 40 - 64 years (OR: 2.72, 95% CI: 1.39 - 5.30, p=0.003) and 65 years and above (OR: 4.85, 95% CI: 2.45 - 9.58, p<0.001). Being from the non-Hispanic (NH) black ethnicity negatively predicted receiving the COVID-19 booster (OR: 0.55, 95% CI: 0.36 - 0.85, p=0.007). Conclusions While COVID-19 vaccination rates are fairly satisfactory in COPD patients, the uptake of booster vaccines is relatively lower in this population. Socioeconomic and behavioral factors are associated with poor vaccine uptake, and targeted interventions should be implemented to address these factors.

Sociodemographic predictors of hypertensive crisis in the hospitalized population in the United States.

INTRODUCTION: Hypertensive crisis (HC) encompasses hypertensive emergencies (HE) and urgencies (HU). METHODS: A retrospective analysis of the 2016-2020 National Inpatient Sample was conducted, and all hospitalizations for HC were identified with their ICD-10 codes. A probability estimation of outcomes was calculated by performing multivariable logistic regression analysis, which took confounders into account. Our primary outcomes were SDs of HC. Secondary outcomes were myocardial infarction (MI), stroke, acute kidney injury (AKI), and transient ischemic attack (TIA). RESULTS: The minority populations were more likely than the Whites to be diagnosed with HCs: Black 2.7 (2.6-2.9), Hispanic 1.2 (1.2-1.3), and Asian population 1.4 (1.3-1.5), (p < 0.0001, all). Furthermore, being male 1.1 (1.09-1.2, p < 0.0001), those with 'self-pay' insurance 1.02 (1.01-1.03, p < 0.0001), and those in the <25th percentile of median household income 1.3 (1.2-1.3, p < 0.0001), were more likely to be diagnosed with HCs. The Black population had the highest likelihood of end-organ damage: MI 2.7 (2.6-2.9), Stroke 3.2 (3.1-3.4), AKI 2.4 (2.2-2.5), and TIA 2.8 (2.7-3.0), (p < 0.0001, all), compared to their Caucasian counterpart. CONCLUSIONS: Being of a minority population, male sex, low-income status, and uninsured were associated with a higher likelihood of hypertensive crisis. The black population was the youngest and had the highest risk of hypertensive emergencies. Targeted interventions and healthcare policies should be implemented to address these disparities and enhance patient outcomes.

Correction: Effect of Avocado Consumption on Risk Factors of Cardiovascular Diseases: A Systematic Review and Meta-Analysis.

[This corrects the article DOI: 10.7759/cureus.41189.].

The Dermatologic Care Needs of a Rural Community in South Florida.

For patients in rural areas, primary care is often their only access to healthcare services, and skin concerns are among the most common diseases seen in these settings. This study aims to investigate the most common skin conditions, management trends and patterns of referral to dermatology in a rural and underserved community in South Florida. A retrospective chart review was conducted using medical records from the C.L. Brumback Primary Care Clinic in Belle Glade, FL. The most common skin conditions were fungal infections, unspecified dermatitis, pruritus, skin cancer concern, alopecia, and autoimmune skin disorders. The most frequent management strategy was medication prescription followed by specialist referral. Of the 21 percent of patients referred to a specialist, 55 percent of these were to dermatology. The most common diagnoses referred to dermatology were atopic dermatitis and alopecia. Only 20 percent of these patients reported attending their follow-up appointment, and the average distance to referral was 21 miles. Belle Glade is unique in its need for and access to dermatologic care. The lack of access to specialists in rural communities is a public health issue that more studies and outreach initiatives should address.

Maternal Seroprevalence and Placental Transfer of COVID-19 Antibodies in Pregnancy: A Hospital-Based Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a relatively new disease with high morbidity and mortality. Information about the prevalence of infections in pregnancy could help identify herd immunity, project epidemics, and decide policy guidelines. OBJECTIVES: The aim of this study was to determine the infection susceptibility risk of COVID-19 in pregnancy, to determine the prevalence of COVID-19 antibodies (IgG & IgM), and to evaluate the determinants of COVID-19 antibody positivity in pregnancy. MATERIALS AND METHODS: This was an analytical cross-sectional study involving 258 consenting pregnant women recruited at Irrua Specialist Teaching Hospital, Edo State, Nigeria. Of these, 179 participants were recruited from the antenatal clinic, and 79 from the gynecology emergency unit. A structured questionnaire was administered at baseline. Venous blood was obtained at enrolment to test for total antibodies using ELISA. A nasopharyngeal swab was simultaneously obtained for COVID-19 PCR for all participants. Umbilical cord blood was taken after delivery in those who had positive serology. Socio-demographic variables and clinical presentation of respondents were considered as exposure variables, and this was cross-tabulated with outcome variables in bivariate analysis using chi-square with a level of significance at a P-value less than 0.05. Variables in bivariate analysis of chi-square that have a P-value less than 0.2 were entered into a logistic regression using multivariate logistic models. RESULTS:  The study detected active COVID-19 infections among 7.4% (19/258) of the study participants. The study demonstrated a seroprevalence of COVID-19 antibodies in 62.4% (161/258) of the participants at recruitment and showed a strong correlation between working in the healthcare setting and living in an urban environment. Our study also reported 5.3% (8/152) of cord blood antibody positivity among study participants. The concentration of maternal immunoglobulin strongly and positively correlated with cord blood seropositivity. CONCLUSION: Prevalence estimates are an underestimate of the actual proportion of pregnant women with prior COVID-19 exposure as observed in the study discrepancy of confirmed PCR infection and evidence of previous infection from serology. The study also highlighted a low efficiency of placental transfer of COVID-19 antibodies at birth among those who were seropositive at baseline and showed that maternal antibody levels play an important role in determining the efficiency of placenta transfer of COVID-19 antibodies in pregnancy.

Association of Bullying Victimization With Suicide Ideation and Attempt Among School-Going Adolescents in Post-conflict Liberia: Findings From the Global School-Based Health Survey.

Background School-based bullying is a global problem that negatively impacts the victims' and perpetrators' health and well-being. There is a paucity of data regarding bullying in schools and its association with suicide behaviors among adolescents in Liberia. Objective The study investigated the impact of bullying victimization on suicidal thoughts and suicide attempts among adolescents in Liberia. It aimed to provide insights into the consequences of bullying victimization on adolescents' mental health regarding their thoughts of self-harm and suicide attempts. Methods The study utilized data from the 2017 Liberia Global School-based Health Survey (GSHS) to analyze information on 2744 students between the ages of 11 and 18 years, with 52.4% being males. Prevalence rates of bullying victimization and suicide behaviors were calculated using descriptive statistics. Multiple logistic regressions were used to model the relationship between being bullied and experiencing suicidal behaviors (ideation and attempts). Results Among the 2744 adolescents examined, 20% experienced suicidal thoughts, with about 30% of the adolescents reporting suicide attempts at some point in the year preceding the survey. Within 30 days prior to the survey, the prevalence of bullying victimization was 50%, with 44.9% experiencing frequent victimization (3 or more days). Bullying victimization was significantly linked to increased odds of suicidal ideation with planning (aOR: 1.86; P < 0.001), at least a suicide attempt (aOR: 2.16; P < 0.001), and multiple attempts at suicide (aOR: 2.67; P < 0.001). We also observed that a greater number of days bullied was dose-dependently associated with higher odds for suicide ideation and attempts. Conclusion These findings support and extend those from other developing countries, highlighting the association between school-based bullying and suicidal behaviors. The relatively high prevalence of bullying among adolescents in Liberia underscores the importance of implementing effective anti-bullying policies and suicide prevention strategies in schools.

Association Between Self-Rated Health and Medical Care Disruption Due to COVID-19 Among Individuals With Atherosclerotic Cardiovascular Disease.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted medical care across diverse populations with varying outcomes. In this study, we evaluated the relationship between health rating and disruption in medical care due to COVID-19 among individuals with atherosclerotic cardiovascular disease (ASCVD). METHODS: Data from the 2020 National Health Interview Survey was used for this study. ASCVD sample included those with self-reported coronary heart disease, stroke, and heart attack. Health rating was represented as fair to poor, good, and very good to excellent. The outcome variable was a disruption of medical care due to COVID-19 (delay in medical care or did not get care). The chi-square test was used for the descriptive analysis and multiple logistic regression was used to evaluate the relationship between health rating and disruption in medical care with demographic factors, comorbidities, and cumulative social risk adjusted for. RESULTS: Among the 31,568 adults, 1,707/31,568 representing 9,385,855 adults 18 years and above with ASCVD reported experiencing or not experiencing a disruption in medical care. After adjusting for cumulative risk, the odds of not getting medical care due to COVID-19 were high for those who rated their health as fair/poor as compared to excellent (adjusted odds ratio (AOR) = 1.95, 95% CI = 1.24-3.08, p = 0.004). These odds remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.84, 95% CI = 1.11-3.06, p = 0.018). After adjusting for cumulative risk, medical care utilization (received, delayed, did not receive) was rated. Those who rated their health as fair to poor as compared to excellent were more likely to report a delay in health care due to COVID-19 (AOR = 1.85, 95% CI = 1.28-2.68, p = 0.001) and remained about the same after adjusting for cumulative social risk, demographic factors, and comorbidities (AOR = 1.86, 95% CI = 1.22-2.82, p = 0.004). Female respondents with ASCVD who rated their health as fair/poor were more likely to experience a delay in medical care due to COVID-19 (AOR = 2.06, 95% CI = 1.06-4.01, p = 0.033) or not get medical care due to COVID-19 (AOR = 2.86, 95% CI = 1.42-5.76, p = 0.003) as compared to those who rated their health as excellent. With regards to men with ASCVD, health rating was not related to their reported disruption of medical care due to COVID-19. CONCLUSIONS: A poor to fair health rating is associated with a delay in getting or not getting medical care among individuals with ASCVD. Further studies are needed to evaluate this relationship further.

Trends and Factors Associated With the Mortality Rate of Depressive Episodes: An Analysis of the CDC Wide-Ranging Online Data for Epidemiological Research (WONDER) Database.

Background Depressive episodes are associated with increased mortality rates across the United States. Recognizing the relationship between depression and physical health, understanding the contributing factors, and addressing disparities are critical in reducing mortality rates and improving the overall well-being of individuals experiencing depressive episodes. Continued research, public health efforts, and collaborative approaches are essential to tackle this complex public health concern effectively. Studying the mortality rate trends of depressive episodes along with other related factors will help enhance the understanding of the condition, which, in turn, will assist in reducing mortality rates in the vulnerable population. Methodology Data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on the Underlying Cause of Death were examined to identify individuals who experienced fatal outcomes related to depressive episodes from 1999 to 2020. The WONDER database refers to the online system used by the CDC to make its various resources accessible to the public and public health experts. CDC WONDER offers access to a broader range of information on public health. Results A total of 13,290 individuals who died from depressive episodes between 1999 and 2020 were identified. Data analysis revealed an overall mortality rate of 0.20 per 100,000 individuals during the specified period. The highest mortality rates were observed in the years 2003 (0.28), 2001 (0.27), and 1999 (0.27). The analysis revealed significant disparities in mortality rates among different demographic groups. Older adults, females, specific racial groups, including Whites and African Americans, and specific geographic areas, including the Midwest, Northeast, South, and West, exhibited higher mortality rates associated with depressive episodes. Conclusions The study identified that older individuals, females, Whites, and African Americans, as well as certain geographic regions, exhibited an increased likelihood of mortality related to depressive episodes. These findings highlight the importance of understanding the complex interplay between mental health and mortality. The findings emphasize the importance of addressing disparities in mental health outcomes among different demographic groups. Identifying vulnerable populations can inform targeted interventions and resources to address the elevated mortality risk.

Mollaret's Syndrome: A Case Report.

Benign recurrent aseptic meningitis is a rare condition characterized by recurring, self-limited episodes of aseptic meningitis. Meningeal irritation typically occurs first, accompanied by fever and mononuclear cell pleocytosis. The diagnosis is only made after other known causes of lymphocytic meningitis have been excluded. Resolution typically occurs within two to seven days without residual neurological deficit. Aseptic meningitis is most frequently caused by viruses; Mollaret's meningitis has been linked to the herpes simplex virus 2 (HSV 2). It is unclear if prophylactic medication is indicated for these patients. We describe a patient who was experiencing her seventh episode of aseptic meningitis.